Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | ME55533 | FL |
NPI | 1093822629 |
---|---|
Provider Name | Adamantia Anna Mammas |
First Address | Orlando, FL 32837-7122 |
Second Address | Lakeland, FL 33805-4543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |